Who Runs Your Day?

WEBVTT

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All right, let's reframe.

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If you're just catching up,

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here's the entire argument in one breath.

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AI isn't here to replace the clinician.

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Used with discipline, it hands back,

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one at a time,

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the five things burnout quietly stole by

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putting a well-behaved agent on the boring

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machinery so the human lands where only a

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human can.

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Now, three so far.

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For each agent wired into the EMR,

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our clinician, Sarah,

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already uses the scribe.

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took documentation off her evenings and

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gave her back presents.

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The revenue agent took billing anxiety out

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of the treatment room and gave back focus.

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And the intelligence agent brought the

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evidence to the table, gave back growth.

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Now today, the fourth in five,

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the one that decides whether Sarah directs

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her day or spends it reacting to one.

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Everybody talks about burnout like it's

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working too many hours,

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but Larry's latest article on Substack

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argues something different.

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Maybe burnout starts much earlier,

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like at seven forty five in the morning

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when you're already reacting to your day

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instead of running it.

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So, Larry, let's start there.

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You began this week's article on Substack

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before the first patient even walks in the

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door.

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You open with Sarah, our clinician,

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standing at her workstation dutifully at

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seven forty five,

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trying to reconstruct her day for memory.

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Who is this again?

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Are they week one or week six?

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Or was that billing issue solved?

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Or is it going to pop up mid-session?

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Why was that the scene you wanted us

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to see first?

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Yeah, it's interesting.

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Each one of these, as you allude to,

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has a different clinical or life concept

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or construct.

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But what I will tell you is when

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you're at your workstation at seven forty

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five trying to reconstruct your day from

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memory,

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the scene that you want to see is

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Nobody logs those fifteen minutes.

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There's not a CPT code for standing at

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a workstation trying to remember twelve

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patients.

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Yet it's the most expensive if you think

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about a quarter hour of the clinical day

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and it's invisible.

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It doesn't show up in a productivity

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report.

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It doesn't show up in an exit interview.

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Your boss doesn't know about it.

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You're not getting these reports saying

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you're not doing it enough.

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You know,

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every clinician listening has lived,

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you know, this exact scene.

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Coffee gets cold,

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doing detective work on your own caseload.

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All those things happen.

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You know,

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I wanted the wound on the table before

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anybody said the letters AI.

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If you feel if you don't feel the

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seven forty five, the rest of the piece,

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frankly, is just a, you know,

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a product demo.

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Yep.

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So, so far,

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we reviewed this in the top of the

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show.

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Presence has been given back.

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Focus is given back.

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Growth is given back.

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This article, it gives back control.

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Why is control something clinicians lose

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so quietly, you add?

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Yeah.

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And it's a big, big part of,

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you know, evolving into burnout.

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In human beings,

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we're control-oriented animals.

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So it's a basic human need to have

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some level of control.

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Losing control doesn't look like a loss,

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but it is.

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It looks like being busy.

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And we hand out medals for being busy.

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Everybody says, oh, I'm so busy.

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Nobody ever sends you a memo saying,

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effective Monday, the schedule runs you.

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It leaves in fifteen-minute increments,

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one squeezed inpatient, a portal message,

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one flyer at a time.

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and you know burnout research which i pay

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a lot of attention to has said for

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a long period of time that lack of

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control is the one core driver you know

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nobody ever writes i lost the order of

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my day on a resignation letter they write

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i'm tired control is the loss that hides

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inside that word tired

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When they say tired,

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they're really saying,

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I'm losing my control.

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And yet you never see it show up

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as a reason people leave.

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But the reality is they no longer feel

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they're in control of their own

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destination, autonomy, purpose, mastery,

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all of those kinds of things.

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The one we dig at is treating therapists

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and doctors like fungible commodities.

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And what that is a real euphemism for

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is we try to take away their control.

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Yeah.

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I always look for lines.

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Like if I had to find a subtitle

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or a pull quote,

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and there's a line I underlined,

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a dangerous master doesn't just bury you

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in work.

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It decides the order you do it in.

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And I've always noticed that the bosses

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that I've had have said,

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I'm going to show you the process and

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the result I'm looking for.

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You sort of figure out how you want

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to do it.

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That feels like you're talking about more

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than AI though.

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What are you really describing?

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Yeah,

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so I have a lot of military influence

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because, you know,

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I was in the army and it's,

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you know, in this case, it's sequence,

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not volume.

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And the one thing the military understands

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better than healthcare does is whoever

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sets the tempo owns the fight.

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The EMR, the inbox, the schedule grid,

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none of them buried Sarah,

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they just sequenced her.

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So it's the tyranny of the urgent is

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really the tiring,

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the tyranny of somebody else ordering

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things.

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So yes, the line is bigger than AI.

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It's every system that took over deciding

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what you do first.

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Drucker's old, you know,

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Peter Drucker's old distinction applies.

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Doing things right is efficiency.

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Doing the right things in that right order

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is the whole job.

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You lose that order sequencing,

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if you will, and the workload,

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wins by default.

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It's another form of loss of control.

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Yeah, spirals out of control.

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You also wrote,

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there's a world of difference between a

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clinician who chooses where her attention

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goes and one who spends the day chasing

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whatever is on fire.

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I feel like anybody who's ever served in

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a clinical environment

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feels this in their gut,

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they've been there.

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So how does someone know when they've

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crossed that line?

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I know, and it always sounds,

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you always start the days with the best

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intentions, right?

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But, you know, I think there's sort of,

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I guess, two tests.

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The one would be the morning test, right?

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The eight AM,

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can you name the two or three patients

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who are going to need the most out

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of you today?

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If the schedule answers before you do,

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the schedule is running the day.

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And then there's the four thirty or five

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o'clock test straight from the piece.

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Did today feel like something you ran?

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Or did it feel like something that ran

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you?

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You don't need a survey instrument.

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Your own end-to-end,

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day-to-day exhaustion tells you which one.

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The chased fire tired is very different

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than a well-run day engagement tired.

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And every clinician,

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every clinician knows the difference.

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And when you feel you've been run over,

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that can happen once in a while.

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But it's when it happens repeatedly.

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And that has just a dramatic effect.

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on your engagement and your wellbeing as a

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person and then what your confidence as a

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therapist.

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Yeah.

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I feel like when most people hear AI,

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especially now where I feel like it's

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being mentioned every other sentence and

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think automation,

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but you describe something smaller

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actually,

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almost like preparing someone to do their

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best work.

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Why is preparation so much more valuable

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than just simply automation?

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yeah no it's interesting you know

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automation removes the human preparation

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fulfills or arms the human so military

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again you know in the military there's a

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big thing i try to do this in

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my own companies they call it the morning

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brief

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And it exists so that the commander walks

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into an already oriented room.

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The staff is prepared,

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the commander decides.

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Nobody calls out automating the commander,

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right?

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The whole discipline of the series is that

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AI drafts, clinician decide,

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it's empowering.

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If AI is gonna be done right,

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it's about,

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empowering the clinician so automation

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what it does when it works well is

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it promises fewer decisions preparation

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delivers better timed ones so if you look

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at sarah at seven forty five a.m doesn't

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need a machine making calls for she needs

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the reconstruction already done so her

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doctorate gets spent on making clinical

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judgment instead of recall that's a

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smaller promise than automation but it's a

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much bigger gift yeah

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I also noticed that you were careful to

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say in your article that the briefing

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doesn't make decisions.

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You just hit on that.

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It reconstructs that day,

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then gets out of the way.

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Why is that distinction so important?

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Hammer that again.

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Yeah,

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so because the minute the tool decides the

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order,

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we've rebuilt the master with better

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manners.

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We're just following it.

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And deciding what matters first,

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who gets more of Sarah today?

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Which flag can wait?

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That's the clinician's job.

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You know that your patients,

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while they may be scheduled every thirty

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minutes,

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some need more of you than others.

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It's never the paperwork.

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And there's a harder edge underneath all

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this, Jimmy.

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The liability stays with the human.

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It stays with the clinician.

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If the briefing decided and Sarah just

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kind of complied with everything,

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we haven't restored control.

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We transferred it effectively to an AI

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vendor.

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You know,

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a servant sets the table and leaves the

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room.

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The moment, you know,

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it starts choosing the menu, you know,

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you got to get out of there.

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Right, right, right, right.

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One thing I did notice in this series

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is the fact that there are five agents.

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There's five distinctions, right?

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And you're sort of highlighting that every

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AI tool has a limit.

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It has a place in guardrails where it's

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good.

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In fact,

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this week you warned that RTM can become

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like more of a surveillance instead of

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support.

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How do leaders know when technology has

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crossed that line or some of those

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guardrails is now acting outside of its

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scope?

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yeah so before we get to the cross

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the line question i just want to remind

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you that you know what i just what

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i had done in this article actually tim

00:09:54.176 --> 00:09:56.557
plin and i had co-wrote an article had

00:09:56.577 --> 00:09:58.259
some help from my son on it on

00:09:58.660 --> 00:10:01.803
very academic oriented ai agents and how

00:10:01.884 --> 00:10:04.606
it could transcribe healthcare and how emr

00:10:04.647 --> 00:10:06.168
companies ought to fulfill it we had even

00:10:06.208 --> 00:10:08.030
backed up with a lot of citations and

00:10:08.051 --> 00:10:09.373
a lot of drawings and graphs

00:10:09.793 --> 00:10:11.452
And it was rejected from the academic

00:10:11.493 --> 00:10:11.893
papers.

00:10:11.913 --> 00:10:12.894
And so I thought, well,

00:10:12.913 --> 00:10:14.894
maybe I can encourage the EMR carriers by

00:10:14.933 --> 00:10:18.475
just going into five potential constructs

00:10:18.855 --> 00:10:21.995
around AI agents that if you really want

00:10:22.274 --> 00:10:25.796
to liven up the clinician and embrace them

00:10:25.956 --> 00:10:27.475
and put them back at the core and

00:10:27.535 --> 00:10:28.956
restore that and prevent burnout,

00:10:28.975 --> 00:10:29.556
you can do it.

00:10:29.917 --> 00:10:32.336
And so this week, we're on number four.

00:10:32.797 --> 00:10:36.118
And when technology has crossed the line,

00:10:36.158 --> 00:10:37.577
I think there's two or three reasons.

00:10:38.677 --> 00:10:40.760
it streams instead of summaries, right?

00:10:40.780 --> 00:10:42.903
If your clinicians are getting pinged in

00:10:42.942 --> 00:10:44.764
real time with step counts and pain

00:10:44.806 --> 00:10:46.346
scores, that's not intelligence.

00:10:47.248 --> 00:10:48.929
That's a dashboard with a leash on it,

00:10:48.971 --> 00:10:49.171
right?

00:10:50.611 --> 00:10:51.533
I would say that's number one.

00:10:51.573 --> 00:10:53.895
Number two is there's no set review time.

00:10:54.417 --> 00:10:56.259
If the data can interrupt any hour of

00:10:56.278 --> 00:10:58.159
the day, like a text message, the tool,

00:10:58.301 --> 00:11:00.341
again, owns the tempo and the sequencing.

00:11:00.962 --> 00:11:02.144
And then I actually think there's probably

00:11:02.183 --> 00:11:02.825
a third thing,

00:11:02.845 --> 00:11:04.426
and this one's sort of the giveaway.

00:11:04.446 --> 00:11:06.607
If the system penalizes patients who don't

00:11:06.648 --> 00:11:07.168
check in,

00:11:07.208 --> 00:11:08.269
you've turned the patient into a

00:11:08.330 --> 00:11:09.591
compliance object, right?

00:11:09.811 --> 00:11:12.854
So you've patterned and you've taught the

00:11:12.913 --> 00:11:13.274
patient.

00:11:14.054 --> 00:11:15.836
The test is one real simple question.

00:11:16.277 --> 00:11:18.258
Does the between visit data

00:11:18.999 --> 00:11:20.519
make the visit better?

00:11:20.880 --> 00:11:23.042
Does it arm the clinician to help the

00:11:23.081 --> 00:11:24.663
patient support him or her?

00:11:25.043 --> 00:11:27.346
If it does, makes the reporting better.

00:11:27.885 --> 00:11:29.206
If it's not,

00:11:29.287 --> 00:11:31.688
it's just surveillance wearing medical

00:11:31.749 --> 00:11:32.250
scrubs.

00:11:32.830 --> 00:11:34.250
And I like RTM.

00:11:35.261 --> 00:11:36.903
I think it should be adopted.

00:11:37.945 --> 00:11:39.707
I hate the vendors who only tell you

00:11:39.727 --> 00:11:41.429
about how it's there to make more money.

00:11:41.889 --> 00:11:42.991
I would do it in the form of

00:11:43.032 --> 00:11:44.192
care because PTs,

00:11:44.553 --> 00:11:47.376
we've heard this our entire life about,

00:11:47.557 --> 00:11:47.638
oh,

00:11:47.658 --> 00:11:48.879
we need to be doing this because it

00:11:48.918 --> 00:11:50.061
produces more revenue.

00:11:51.052 --> 00:11:53.653
Now I think we have an ability to

00:11:54.034 --> 00:11:55.115
implement RTM,

00:11:55.556 --> 00:11:56.735
but if implemented incorrectly,

00:11:56.755 --> 00:11:58.096
it's only going to contribute to moral

00:11:58.136 --> 00:11:59.138
injury and more burnout.

00:11:59.278 --> 00:12:00.519
And we have to be careful about that.

00:12:00.578 --> 00:12:01.000
And frankly,

00:12:01.039 --> 00:12:02.701
I think that's where it's at right now.

00:12:02.740 --> 00:12:05.123
And then you have leaders coming in and

00:12:05.302 --> 00:12:06.724
unprofessional managers coming in and

00:12:06.744 --> 00:12:07.803
saying, don't even do RTM.

00:12:07.823 --> 00:12:08.705
It doesn't pay enough.

00:12:10.187 --> 00:12:12.229
You got to use another lens.

00:12:12.688 --> 00:12:13.668
Yeah, that stings.

00:12:14.428 --> 00:12:16.610
There's another line that I liked and

00:12:16.649 --> 00:12:17.090
highlighted.

00:12:17.149 --> 00:12:18.770
A clinician who spends the morning

00:12:18.850 --> 00:12:20.350
reconstructing her day from memory has

00:12:20.410 --> 00:12:23.912
already lost the part of it that mattered

00:12:23.991 --> 00:12:24.491
most.

00:12:25.212 --> 00:12:26.832
What has she actually lost?

00:12:27.253 --> 00:12:29.274
Is it the thing we're fighting for in

00:12:29.313 --> 00:12:29.693
this one?

00:12:29.734 --> 00:12:31.495
Is it directing their day?

00:12:32.634 --> 00:12:33.034
What is it?

00:12:33.054 --> 00:12:35.235
Yeah, so you've just primed.

00:12:36.061 --> 00:12:39.423
and connected that therapist and they've

00:12:39.442 --> 00:12:40.764
lost their eight AM patient,

00:12:40.783 --> 00:12:43.225
that very first patient.

00:12:43.264 --> 00:12:45.167
They got a clinician who was physically in

00:12:45.206 --> 00:12:45.567
the room,

00:12:45.606 --> 00:12:47.128
but mentally still assembling their

00:12:47.168 --> 00:12:47.567
caseload.

00:12:47.727 --> 00:12:48.568
They're half present.

00:12:49.269 --> 00:12:50.769
They're doing memory work with somebody

00:12:50.830 --> 00:12:52.551
telling them about their weekend flare up

00:12:52.971 --> 00:12:55.633
with all kinds of information and data

00:12:56.092 --> 00:12:57.913
that is just hard to really piece and

00:12:57.933 --> 00:12:58.855
assimilate together.

00:12:59.414 --> 00:13:01.376
You know, presence is not a warm-up act.

00:13:01.518 --> 00:13:02.138
You know,

00:13:02.158 --> 00:13:03.659
the first ten minutes of a visit and

00:13:03.679 --> 00:13:05.402
really the first sixty, ninety seconds,

00:13:05.442 --> 00:13:08.065
according to the research, is connection.

00:13:08.085 --> 00:13:09.667
And connection is dosage.

00:13:10.106 --> 00:13:12.089
And that has to be done correctly.

00:13:12.409 --> 00:13:13.951
You have to have presence.

00:13:14.231 --> 00:13:16.333
You have to have attunement and empathetic

00:13:16.374 --> 00:13:16.793
listening.

00:13:17.475 --> 00:13:18.495
and on top of that you have to

00:13:18.514 --> 00:13:19.936
have a boundary about it we can talk

00:13:19.956 --> 00:13:22.136
about that at a different time but the

00:13:22.177 --> 00:13:24.738
bigger loss is you've lost that presence

00:13:24.778 --> 00:13:26.778
you've lost that first fresh attention

00:13:27.177 --> 00:13:28.938
because the best hour of clinical thinking

00:13:28.958 --> 00:13:30.299
she'll have all day got spent on

00:13:30.360 --> 00:13:32.519
reconstructing her patient load the single

00:13:32.679 --> 00:13:36.001
lowest level of use of a license operating

00:13:36.022 --> 00:13:37.501
at the top of the license doctoral

00:13:37.562 --> 00:13:39.783
education you don't get that you don't get

00:13:39.802 --> 00:13:41.484
that hour back at three o'clock you can

00:13:41.504 --> 00:13:42.504
write it off it's gone

00:13:43.038 --> 00:13:43.258
Right.

00:13:43.677 --> 00:13:45.740
If an operator is listening now and they

00:13:45.779 --> 00:13:47.980
walked into work tomorrow morning,

00:13:48.081 --> 00:13:49.942
what's one thing they could change that

00:13:49.962 --> 00:13:52.524
would help them feel like they were

00:13:52.544 --> 00:13:54.625
running in the day instead of the reverse,

00:13:54.706 --> 00:13:55.846
instead of the day running them?

00:13:56.519 --> 00:13:58.260
yeah i'll relate it to business and we

00:13:58.301 --> 00:14:01.024
call it the daily huddle and it is

00:14:01.124 --> 00:14:03.326
a really evidence-based part of having a

00:14:03.405 --> 00:14:05.467
successful business is the daily huddle we

00:14:05.508 --> 00:14:07.669
talked about this in the meeting podcast

00:14:07.690 --> 00:14:09.851
series so go back and listen to that

00:14:10.273 --> 00:14:12.033
so now at a clinic level they need

00:14:12.053 --> 00:14:13.775
the daily huddle to get updated around

00:14:13.816 --> 00:14:16.038
their clinic but then they need fifteen

00:14:16.077 --> 00:14:19.361
minutes back on purpose before you open

00:14:19.601 --> 00:14:20.163
anything

00:14:21.181 --> 00:14:23.001
you have to have that fifteen minutes.

00:14:23.101 --> 00:14:25.943
No inbox, no portal, no fires.

00:14:26.465 --> 00:14:28.225
Look at the day and answer one question.

00:14:28.546 --> 00:14:30.326
Which two or three patients gets the best

00:14:30.386 --> 00:14:31.248
of me today and why,

00:14:31.288 --> 00:14:32.129
or gets more of me?

00:14:32.188 --> 00:14:33.529
Write it down, three lines.

00:14:33.950 --> 00:14:35.791
Then let everything else route around that

00:14:35.831 --> 00:14:37.913
decision instead of everything else

00:14:37.952 --> 00:14:39.813
directing your decision another way.

00:14:40.374 --> 00:14:42.916
And I think here's the part that people

00:14:43.056 --> 00:14:43.375
miss.

00:14:43.416 --> 00:14:44.996
You don't need a single piece of AI

00:14:45.017 --> 00:14:45.557
to start.

00:14:46.057 --> 00:14:48.080
Control begins as a decision.

00:14:48.885 --> 00:14:51.629
not a technology the agent the briefing

00:14:51.870 --> 00:14:55.474
rtm all that just makes the reconstruction

00:14:55.533 --> 00:14:57.475
free so the fifteen minutes gets spent on

00:14:57.557 --> 00:15:00.840
judgment instead of detective work but the

00:15:01.041 --> 00:15:04.024
ownership move is yours and it's available

00:15:04.345 --> 00:15:06.326
at seven forty five a a a m

00:15:06.386 --> 00:15:07.427
the day you react

00:15:08.291 --> 00:15:09.910
to a day is a day you've already

00:15:09.971 --> 00:15:11.932
lost because you cannot ever get ahead

00:15:11.991 --> 00:15:12.211
again.

00:15:12.231 --> 00:15:13.732
So take that first fifteen minutes.

00:15:14.253 --> 00:15:14.873
You won.

00:15:14.952 --> 00:15:15.952
Take it in that order.

00:15:16.493 --> 00:15:18.053
And that order, that sequencing,

00:15:18.094 --> 00:15:19.754
as we've said, is the whole game.

00:15:19.894 --> 00:15:21.554
When you lost the ability to control your

00:15:21.575 --> 00:15:22.335
own sequencing,

00:15:22.394 --> 00:15:24.975
it really goes downhill from there.

00:15:24.995 --> 00:15:27.317
This series has never really been about

00:15:27.517 --> 00:15:29.057
AI, not specifically.

00:15:29.076 --> 00:15:31.018
It's been more about what AI should give

00:15:31.057 --> 00:15:31.357
back.

00:15:31.418 --> 00:15:32.878
This week it was control,

00:15:33.298 --> 00:15:35.078
not more productivity or not more

00:15:35.119 --> 00:15:36.779
notifications, not more billing,

00:15:36.820 --> 00:15:37.879
not another dashboard.

00:15:38.600 --> 00:15:39.821
but just a chance to start your day

00:15:39.861 --> 00:15:41.341
knowing you're the one running it,

00:15:41.402 --> 00:15:42.663
not the other way around.

00:15:42.942 --> 00:15:44.543
If you're following Cult Care and the Age

00:15:44.582 --> 00:15:45.823
of AI on Substack,

00:15:45.844 --> 00:15:47.664
you can subscribe there to the operator.

00:15:48.044 --> 00:15:48.565
It is free.

00:15:48.684 --> 00:15:50.765
Part five is where Larry brings the entire

00:15:50.826 --> 00:15:51.566
series home.

00:15:52.125 --> 00:15:56.528
Until next time, keep operating.

00:15:56.548 --> 00:15:57.028
Thanks, Jimmy.

00:15:57.847 --> 00:15:58.589
All right.

00:15:58.649 --> 00:15:59.149
How are we doing on the